Keller Skin & Cancer Care PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

KELLER SKIN & CANCER CARE PC

Doing business as

Keller Skin Care

Practice address

1605 E Riverside Drive
Eagle, ID 83616

Phone

(208) 939-6227

Fax

(208) 939-6442

NPI assigned

Feb 11, 2012

Last updated

Nov 3, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wade Robert Keller, DONPI 1942402169

Title

President

Phone

(208) 939-6227

Specialties & licenses 4

Addresses

Other names 1

• Keller Skin Care Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: wkeller@kellerskin.emadirect.md

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wade Robert Keller, D.O.

  • Dermatology Physician
  • Eagle, ID
  • NPI 1942402169
  Medicare reassignment Care Compare group Authorized official
• Angela Ann Coyne, PA

  • Medical Physician Assistant
  • Eagle, ID
  • NPI 1538276928
  Medicare reassignment Care Compare group
• Heather Nicole Knutson, N.P.

  • Dermatology Physician
  • Eagle, ID
  • NPI 1215936034
  Medicare reassignment Care Compare group
• Matthew Valley, PA-C

  • Medical Physician Assistant
  • Eagle, ID
  • NPI 1447483086
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1649543323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 E RIVERSIDE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166237",
            "telephone_number": "208-939-6227",
            "fax_number": "208-939-6442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 E RIVERSIDE DRIVE",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-939-6227",
            "fax_number": "208-939-6442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLER SKIN & CANCER CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-11",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-939-6227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "O-0559",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wkeller@kellerskin.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Direct Mail Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1605 E Riverside Drive",
            "city": "Eagle",
            "state": "ID",
            "country_code": "US",
            "postal_code": "83616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Keller Skin Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Keller Skin Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kara Maria Katzenmeyer, OTR/L
• Chandler Kaye Kauffman, OD
• Michael A Kaylor, M.D.
• Austin Patrick Keaney
• Madyson Keating
• Wade Robert Keller, D.O.
• David J Kelly, MD
• Lindsay Rae Kenley, NCC, LPC
• Alare Kerstetter
• Key Stone Health Care

• Dermatology Physician in Eagle, ID
• Providers in Eagle, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.